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Fundacion Mexicana para la Salud, Tlalpan, Mexico; and * Universidad Autonoma Metropolitana, Unidad Xochimilco, Mexico
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INTRODUCTION |
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 TOP INTRODUCTION Ancestry and educationEarly work in child...Malnutrition and mental...The ecological approach to...The preparatory work of...CorollaryREFERENCES |
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Ancestry and education |
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TOPINTRODUCTIONAncestry and educationEarly work in child...Malnutrition and mental...The ecological approach to...The preparatory work of...CorollaryREFERENCES |
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His experience as a military medical student left an important imprint on his character that, as he later acknowledged, helped him to develop an egalitarian perspective—all soldiers are equal beneath the uniform. This training aroused an interest in Public Health and strengthened his administrative skills. After graduating in 1945, he earned a Master’s Degree in Public Health, and in 1948, clinical pediatrics caught his interest. He joined the Hospital Infantil de Mexico (HIM), and from 1950 to 1952, he pursued postgraduate training in pediatrics, initially at the University of Illinois College of Medicine, and subsequently at the Bellevue Medical Center of NYU. Cravioto’s formal training in scientific methodology started in 1952 at the Sloan Kettering Institute for Cancer Research, and he complemented it with postgraduate training in Biochemistry at the University of Göteborg, Sweden, from 1954 to 1955.
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Early work in child malnutrition |
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TOPINTRODUCTIONAncestry and educationEarly work in child...Malnutrition and mental...The ecological approach to...The preparatory work of...CorollaryREFERENCES |
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). Their stratification
of malnutrition helped systematize the clinical observations and
allowed comparisons with findings of other researchers. Cravioto had
joined the group when research had focused on the understanding of the
biochemical immaturity of severely malnourished children
(Cravioto 1962
). Their report led to the adoption of new
forms of electrolytes and dietary treatment of malnutrition, which
proved essential to decrease the high mortality associated with this
condition. He worked with Ramos-Galvan and Frenk to produce the
first description of the nutritional recovery syndrome (Gomez et al. 1952
) and to create an inventory of the pathophysiologic
and clinical characteristics of severe infant malnutrition, leading to
the publication of a systematization of the available knowledge of this
clinical condition (Ramos-Galvan and Cravioto 1958
). |
Malnutrition and mental development |
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TOPINTRODUCTIONAncestry and educationEarly work in child...Malnutrition and mental...The ecological approach to...The preparatory work of...CorollaryREFERENCES |
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According to Brozek (1994)
, the first steps taken in
this direction have to be credited to Federico Gomez, who was the first
author of a 1954 publication in Spanish that gave the first
systematized description of the psychological characteristics of
malnourished children. This paper mentioned the application of the
Infant Gesell Scale (Gomez et al. 1954
). At that time,
Geber and Dean were doing similar work in Uganda, but their results
were not published until later (Gerber and Dean 1956
).
After this pioneer work, systematic research on the psychological
manifestations of malnutrition upon entry to the hospital and during
rehabilitation, using the Gesell Infant Scale, was undertaken by
Cravioto. He made a preliminary communication of his findings before
the Mexican Society of Pediatric Research in 1959. This work was soon
followed by a second presentation to the same scientific society on the
influence of certain ecological factors on the behavior of the rural
malnourished child. A formal publication in Spanish appeared that same
year, but the English version was not published for some years
(Cravioto and Robles 1965
).
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The ecological approach to the study of the late effects of malnutrition |
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TOPINTRODUCTIONAncestry and educationEarly work in child...Malnutrition and mental...The ecological approach to...The preparatory work of...CorollaryREFERENCES |
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).This paper also included information on the incidence of
infectious episodes and their effect on childhood growth. A fundamental
question of children malnutrition received a preliminary answer, i.e.,
growth falters around 4 mo of age in malnourished children living in
rural environments. |
The preparatory work of Guatemala |
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TOPINTRODUCTIONAncestry and educationEarly work in child...Malnutrition and mental...The ecological approach to...The preparatory work of...CorollaryREFERENCES |
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).In addition, the ongoing
epidemiologic research program on rural malnutrition of INCAP
(Scrimshaw et al. 1968
) offered him the opportunity to
develop and test in the field an array of methods for evaluating mental
performance in children. Perhaps, Cravioto himself offered the best
description of the state of knowledge of malnutrition-mental
performance relationships at that time, in the opening commentary of
the Current Contents issue of August 20, 1979, which
designated Cravioto et al. 1966
as "This Week’s
Citation Classic": "In 1961 it was apparent that treatment based on our knowledge of the biochemical pathology of malnutrition had markedly increased the number of survivors. Since malnutrition could not only decelerate certain aspects of biochemical maturation but also was capable of producing retrogressions to earlier age specific patterns, we became concerned with the possibility that significant lags in nervous system maturation might also have occurred. It was decided to best document if the reductions in body size characteristic of survivors of early malnutrition were associated with reduced mental development. This decision was based on the consideration that a negative finding would indicate that the lower performance found in malnutrition was a transient phenomenon, which disappeared with nutrition rehabilitation. On the other hand if children after the severe episode still exhibit significant lags, the implications for policy making and national economic planning would be of such an importance that a systematic investigation of the intervening nutritional and non-nutritional factors should be carried on. On a personal basis, this would mean leaving the laboratory of biochemistry to enter the realm of behavioral sciences starting from scratch to learn psychology and social anthropology.
At the end of 1962, it was clear that in survivors of early
severe malnutrition decreased body size was associated with lower
intelligence scores. The time was now ripe for the examination of some
of the primary mechanisms underlying cognitive growth, since the
psychological tests used only partially suggest the manner in which the
nervous system functioning is altered to result in lower levels of
intelligence. While searching for a meaningful procedure for measuring
brain function, Voronin and Guselnikov’s paper on the phylogenesis of
internal mechanisms of the analytic and synthetic activity of the brain
(Voronin and Guselnikov 1963
) attracted our interest;
the problem was how to make operational for the child an experimental
study of phylogenesis. In deciding how to devise an appropriate test,
Herbert G. Birch’s monograph on intersensory development(Birch and Lefford 1964
) answered our dilemma. Now we could ask if in
humans malnutrition influences neurointegrative development as it
influences body size. But how to control for the non-nutritional
variables that affect mental growth? Since our knowledge of relevant
and irrelevant factors was not good enough to make a meaningful
selection, we opted for including a question on the role of the
socio-economic deprivation generally present in the context of
malnutrition.
Birch was invited to review a draft of the paper and to join us as coauthor. His positive response started a truly rewarding association with a most human scientist whose untimely death deprived us of science and affection. Perhaps the many questions raised and left unanswered in the paper, its review of the literature available in English and other languages, a nonintervention research design, the first attempt to test for brain function without intelligence tests, and data documenting that in underprivileged societies bigger is better, while in affluent societies bigger is irrelevant, are our guesses as to why this work is frequently cited."
Cravioto returned to Mexico in 1965 to look for answers to the many
questions that his work in Guatemala had left unanswered. He took
advantage of the experience gained in rural settings from the
pioneering studies of the Hospital Infantil. He began a study in which
he followed a cohort of all children born in a community in a given
year. Of his cohort of 334 children, 22 (7%) developed severe
malnutrition. He doggedly followed his cohort for 22 y and
collected very important and unique information on the effects of
malnutrition in human development. A full description of his
methodologies can be found in the Monograph published by the Society
for Research in Child Development in 1969 (Cravioto et al. 1969
). Because of its importance, we will underscore a few
points related to this investigation.
Two sets of variables were systematically searched for, i.e., those
relating to the child’s family circumstances and background
environment, and those relating directly to the child. The background
factors involved family interactions, biologic factors and general
environmental conditions. The variables of interest of the child ranged
from survival to aspects of physical and behavioral change with age.
From his data, two observations deserve special mention. They were the
profile of the mother’s behavior assessed during the child’s
examination using the methodology developed by Nancy Bailey, and the
inventory of the stimulation available in the home environment
developed by Caldwell (1967)
. It is possible that
Cravioto and his colleagues were the first researchers to collect these
variables longitudinally in a systematic manner in a rural setting, and
relate them to the etiology of infant malnutrition.
The key analytical strategy implemented by Cravioto was to contrast
children who developed severe malnutrition with a group of matched
controls from the same cohort. The findings confirmed the independent
effect of nutritional deprivation on the areas of mental function,
particularly language. One major conclusion of this approach was that
deprivation acts synergistically with the mother-child interaction,
and with the quality of the social environment available during
critical periods of the child’s development. Several publications on
this topic appeared in the 1970s and early 1980s, in Spanish and
English. In 1982, a compilation of the methods and findings of nearly
16 years of longitudinal research was published in Spanish under the
auspices of UNICEF (Cravioto and Arrieta 1982
). Spain
honored this book in 1984 with the "Reina Sofia de España"
award.
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Corollary |
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TOPINTRODUCTIONAncestry and educationEarly work in child...Malnutrition and mental...The ecological approach to...The preparatory work of...CorollaryREFERENCES |
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Cravioto received honorary degrees from the University of Göteborg in Sweden, and Tufts University, in Boston. He also received many awards and distinctions such as the Purkinje Medal of the Czechoslovak Academy of Sciences, The National Award of Sciences of Mexico and the W. O. Atwater Medal of the U.S. Department of Agriculture. Until the early 1990s, he was deeply engaged in building a multidisciplinary research institution in Mexico, aimed at testing under experimental conditions many of his field observations. His plan was to study the basic biological mechanisms responsible for the effects of nutritional deprivation on developmental processes. He succeeded partially, although he had to face institutional setbacks due to a severe economic and political crises in Mexico during the last decade. However, Cravioto’s seminal work continues to be quoted in the current biomedical literature.
Joaquin Cravioto married Cristina O’Farrill and they raised two
children, Patricia and Alejandro. Patricia is an anthropologist doing
epidemiologic research on drug addiction. Alejandro, following his
father’s footsteps, has made basic contributions in the field of
enteral infections and child malnutrition. Cristina, who lives in
Mexico City, still keeps the family house, which was, in Cravioto’s
own words, her domain. Of his many character traits to be remembered,
perhaps the most salient was his capacity to enjoy life and the company
of friends from many parts of the world.FIGURE
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REFERENCES |
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TOPINTRODUCTIONAncestry and educationEarly work in child...Malnutrition and mental...The ecological approach to...The preparatory work of...CorollaryREFERENCES |
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1. Birch H. G., Lefford A. Two strategies for studying perception in "brain damaged" children. Birch H. G. eds. Brain Damage in Children: Biological and Social Aspects 1964:46 Williams and Wilkins Baltimore, MD.
2. Brozek J. Inadecuado consumo de alimentos: historia de la investigacion sobre sus efectos conductuales en sujetos humanos. Rev. Latinoam. Psicol. 1994;26:381-401
3.
Caldwell B. M. Descriptive evaluations of child development and developmental settings. Pediatrics 1967;40:46-56
4. Cravioto J. Appraisal of the effect of nutrition on biochemical maturation. Am. J. Clin. Nutr. 1962;11:484-492[Medline]
5. Cravioto J., Arrieta R. Nutricion, desarrollo mental, conducta y aprendizaje 1982 UNICEF Mexico.
6. Cravioto J., Birch H. G., de Licardie E., Rosales L., Vega L. Monogr. Soc. Res. Child Dev. 1969;34:1-76
7.
Cravioto J., de Licardie E. R., Birch H. G. Nutrition, growth and neurointegrative development: an experimental and ecologic study. Pediatrics 1966;38(2 Part II):319-372
8. Cravioto J., Robles B. Evolution of adaptive and motor behavior during rehabilitation from kwashiorkor. Am. J. Ortopsychiatry 1965;35:449-464
9. Geber M., Dean R.F.A. The psychological changes accompanying kwashiorkor. Courrier 1956;6:3-17
10.
Gomez F., Ramos-Galvan R., Cravioto J. Nutritional recovery syndrome (preliminary report). Pediatrics 1952;10:513-526
11. Gomez F., Ramos-Galvan R., Cravioto J., Frenk S. Malnutrition in infancy and childhood, with special reference to Kwashiorkor. Adv. Pediatr. 1955;7:31
12. Gomez F., Velazco J., Ramos-Galvan R., Cravioto J., Frenk S. Estudios sobre el niño desnutrido. XVII. Manifestaciones psicologicas. Bol. Med. Hosp. Infant. Mex. 1954;11:631-641[Medline]
13. Gordon J. E., Singh S., Wyon J. B. Demographic characteristics of deaths in eleven Punjab villages. Indian J. Med. Res. 1963;51:906
14. Perez-Navarrete J., Vega L., Vilchis A., Arrieta R., Santibañez E., Rivera L., Cravioto J. Operacion Zacatepec. V. Estudio longitudinal de un grupo de niños a los que se les siguio durante su primer año de vida en la Villa de Tlaltizapan. Mor. Bol. Med. Hosp. Infant. Mex. 1960;17:1960
15. Ramos-Galvan R., Cravioto J. Desnutricion en el niño. Concepto y ensayo de sistematizacion. Bol. Med. Hosp. Infant. Mex. 1958;15:763-788[Medline]
16. Scrimshaw N. S., Taylor C. E., Gordon J. E. Interactions of Nutrition and Infection 1968 WHO Monograph Geneva, Switzerland.
17. Voronin L. G., Guselnikov V. I. On the phylogenesis of internal mechanisms of the analytic and synthetic activity of the brain. Pavlov J. Higher Nerv. Act. 1963;13:193
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